Treating Pelvic Congestion Eases Leg Venous Reflux Pain

Pelvic pain related to pelvic venous congestion often occurs in women with symptomatic lower extremity venous reflux. Treating ovarian venous incompetence with embolotherapy can not only reduce associated pelvic pain, but can also significantly reduce the pain associated with lower extremity reflux, according to Carl M. Black, M.D.

Because the disorders often occur together, Dr. Black of Provo, Utah, recommends that those with complex nonsaphenous superficial lower extremity venous insufficiency be questioned regarding concomitant symptoms of pelvic congestion.

Symptoms of pelvic congestion syndrome are heaviness in the pelvis with standing, low abdominal pain, painful varicosities in branches around the labia and vulva, and varicosities that emerge from the gluteal region and extend into the legs. “About 16% of women with varicose veins will say they have pelvic pain that cycles with their leg pain,” he said in an interview.

At the annual meeting of the Society of Interventional Radiology, Dr. Black presented the results of a study evaluating transcatheter embolization in patients with both disorders and included 160 women with symptomatic lower extremity superficial reflux. Each patient received a lower extremity venous duplex ultrasound, which included evaluation of atypical transpelvic venous reflux. Clinical and ultrasonographic findings suggested pelvic congestion syndrome in 26 (16%) women. All 26 had complex nonsaphenous patterns of lower extremity venous reflux.

Twenty-four of these patients underwent venography, which confirmed ovarian venous insufficiency in 22. These 22 patients had embolotherapy on the insufficient pelvic veins. Embolization was successful in 100%. After embolization, 19 (86%) had relief or significant reduction in pelvic pain and 14 (63%) reported reduction of both pelvic and lower extremity pain. After subsequent comprehensive treatment of remaining identifiable sources of lower extremity venous reflux, 20 of the 22 patients reported sustained overall treatment satisfaction, with 60% of patients having been followed between 6 and 12 months.